Ann Ital Chir. 2023;94:56-62.
The use of minimally invasive surgery in colon cancers is becoming widespread and developing day by day Laparoscopic right hemicolectomy (LRHC) with complete mesocolic excision is gradually becoming the standard oncological surgical principle for right hemicolectomy. The aim of our study was to evaluate the safety and efficacy of laparoscopic right hemicolectomy in a small-volume center.
Clinical outcomes were analyzed in a study comparing laparoscopic right hemicolectomy with conventional right hemicolectomy. By standardizing laparoscopic right hemicolectomy in our center, data on patient characteristics, surgical details, tumor, lymph node, and metastasis stage (TNM), postoperative recovery, and survival were retrieved and analyzed from retrospective databases.
Patients underwent open (n. 63) and laparoscopic (n. 51) right hemicolectomies in our units. In the laparoscopic group, the rate of conversion to open was 5.8%, and there was no mortality for 30 days. In the open group, the first-month mortality was 6.3%, and the rate of complications was 15.9%. The mean age of the patients in the laparoscopic group (65.7±13.46) was statistically significantly higher than that of the open group 60.49±12.67) (p=0.042). Operation time was 147.53±57 minutes in the laparoscopic group and 132.84±34 minutes in the open batch, and there was no statistically significant difference between them. Significant correlations were found between stage and cancer subgroup information (p=0.001). Adenocarcinoma (42%) and mucinous (43.8%) type cancers were found more frequently in patients with stage III, while signet ring cancers were more common (100%) in stage IV patients.
LRHC and laparoscopic conventional right hemicolectomy offered similar oncologic outcomes for right colon cancers in small volume centers. LRHC can be performed safely, and sufficient laparoscopic experience is essential for it to be considered the gold standard procedure. With an improved standard technique and systematic learning method, patient safety and surgical results can be achieved as successfully as in the open surgical approach.
Colorectal cancer, Intracorporeal anastomosis, Right laparoscopic hemicolectomy, Side-to-side anastomosis.
在小容量中心评估腹腔镜右半结肠切除术的安全性和有效性。
通过在我们中心规范化腹腔镜右半结肠切除术，从回顾性数据库中检索并分析了患者特征、手术细节、肿瘤、淋巴结和转移分期（TNM）、术后恢复和生存数据。
我们单位的患者接受了开放（n=63）和腹腔镜（n=51）右半结肠切除术。腹腔镜组中转开腹率为 5.8%，30 天内无死亡率。开放组首月死亡率为 6.3%，并发症发生率为 15.9%。腹腔镜组患者的平均年龄（65.7±13.46）明显高于开放组（60.49±12.67）（p=0.042）。腹腔镜组的手术时间为 147.53±57 分钟，开放组为 132.84±34 分钟，两组之间无统计学差异。分期和癌症亚组信息之间存在显著相关性（p=0.001）。III 期患者中更常发现腺癌（42%）和黏液癌（43.8%），而 IV 期患者中更常见印戒细胞癌（100%）。
LRHC 和腹腔镜常规右半结肠切除术在小容量中心对右半结肠癌提供了相似的肿瘤学结果。LRHC 可以安全进行，充分的腹腔镜经验对于将其视为金标准手术至关重要。通过改进的标准技术和系统的学习方法，可以实现与开放式手术一样的患者安全性和手术效果。
结直肠癌，腔内吻合，腹腔镜右半结肠切除术，侧侧吻合。
